FOOT AND ANKLE FUSIONS IN CHARCOT-MARIE-TOOTH DISEASE

We reviewed 15 patients with Charcot-Marie-Tooth disease who were trea ted with foot or ankle fusions. Altogether, 26 feet were treated with fusions and the average follow-up time was 14 years. In half of the pa tients the principal symptom leading to fusion operation was instabili ty of the ankle. In four patients, in two of them bilaterally, soft ti ssue corrections were performed before the fusion. In 21 cases, a subt alar triple arthrodesis was performed and each time correction to neut ral position was the aim. In six feet, the triple arthrodesis was comp lemented by soft tissue plastics, e.g., plantar release, Achilles elon gation. or transposition of tibial or peroneal tendons in order to ach ieve proper balance. Other primary fusions were a Grice-type fusion in one case, pantalar arthrodesis in one case, talocrural fusion in one case, and interphalangeal fusions in both feet in one patient with ext reme claw foot. In four cases the triple arthrodesis failed to fuse (t hree nonunions and one delayed union). and new fusions were successful in three of them. The one pantalar fusion in the series was done for a 58-year-old man with late onset of the disease who had a very severe cavovarus deformity at the time of the operation, and this fusion fai led to unite. In 17 of 26 feet, other operations than the primary fusi on were performed, and five feet were operated on three or four times. In four feet the result was judged as excellent, in 15 good, in four fair, and in three poor. There were not more poor results in patients followed up for more than 15 years than in those whose follow-up was s horter. Evaluation of the surgical results in the present series sugge sts that triple arthrodesis can preserve acceptable function in the ma jority of patients with foot deformities and instabilities which are c aused by Charcot-Marie-Tooth disease.